OUR MISSION

We save lives, transform health systems, and catalyze global change

PIVOT MADAGASCAR

Proving what’s possible for health systems everywhere

In collaboration with government partners, Pivot designs and tests public health system strengthening solutions to save lives in rural Madagascar, one of the world’s most complex health environments.

What’s at stake:

CHILD HEALTH

1 in 13

children die before the age of 5

SOCIOECONOMICS

75%

of the population lives in extreme poverty

ACCESS TO CARE

75%

of families live in remote rural communities

YOUTH

50%

of the population is under the age of 18

BIODIVERSITY

90%

of the wildlife is found nowhere else on earth

CLIMATE VULNERABILITY

#1

most climate-vulnerable island nation in Africa

We start where the gaps are widest

From climate vulnerability and emerging disease threats to extreme poverty and geographic isolation, Madagascar sits at the nexus of the forces shaping the future of global health. By confronting this complexity head-on, Pivot is demonstrating what it takes to build stronger, more resilient health systems in even the most challenging environments.

WHERE WE WORK

Our integrated approach

Pivot doesn’t rely on any single intervention.

We weave together proven solutions – from infrastructure and training to data and policy – into an integrated model designed to strengthen every layer of the public health system.

We approach our work with an uncommon
commitment to scientific rigor, embedding research across our interventions to test what works, understand what doesn’t, and improve relentlessly.

WHAT WE DO

Since 2014,
Pivot has supported

>2.2M
patient visits

across all levels of care

How we know it works

Since 2014, Pivot has been measuring population health outcomes in Ifanadiana District.

In 2025, our landmark 10-year impact study demonstrated how Pivot-supported areas experienced significant health gains, outpacing trends in comparison areas both locally and nationally.

2.1x increase

in patient visits

With out-of-pocket fees removed, patients of all ages now seek care when sick twice as often as they did ten years ago

31% reduction

in child mortality

Over the course of a decade, under-5 mortality rates dropped dramatically in Pivot-supported areas

40% increase

in facility-based births

Mothers in Ifanadiana are opting for safe, skilled deliveries at unprecedented rates

READ THE STUDY
MORE PIVOT IMPACT

Featured

October 25, 2025

Building Stronger Health Systems Saves Lives, Madagascar Experiment Shows

by Jake Miller

Harvard Medical School

Go to article
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